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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2013

01-05-2013 | Pediatric Original

Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial

Authors: Philippe A. Jouvet, Valérie Payen, France Gauvin, Guillaume Emeriaud, Jacques Lacroix

Published in: Intensive Care Medicine | Issue 5/2013

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Abstract

Purpose

Duration of weaning from mechanical ventilation is decreased with the use of written protocols in adults. In children, the use of written protocols has not had such an impact.

Methods and measurements

We conducted a single-center trial to assess the feasibility of conducting a multicenter randomized clinical trial comparing the duration of weaning from mechanical ventilation in those managed by a computer-driven explicit protocol versus usual care. Mechanically ventilated children aged between 2 and 17 years on pressure support and not receiving inotropes were included. After randomization, children were weaned either by usual care (n = 15) that was characterized by no protocolized decisions by attending physicians, or by a computer-driven protocol (Smartcare/PS™, Drager Medical) (n = 15). Weaning duration until first extubation was the primary outcome. For comparison, a Mann–Whitney U test was employed (p < 0.05).

Results

Patients characteristics at inclusion were similar. The median duration of weaning was 21 h (range 3–142 h) in the SmartCare/PS™ group and 90 h (range 4–552 h) in the usual care group, p = 0.007. The rate of reintubation within 48 h after extubation and the rate of noninvasive ventilation after extubation in the SmartCare/PS™ and usual care groups were 2/15 versus 1/15 and 2/15 versus 2/15, respectively.

Conclusions

A pediatric randomized trial on mechanical ventilation with a computerized protocol in North America is feasible. A computer-driven protocol that also manages children younger than 2 years old would help to decrease the number of PICU admissions screened in a multicentre trial on this topic.
Appendix
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Metadata
Title
Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial
Authors
Philippe A. Jouvet
Valérie Payen
France Gauvin
Guillaume Emeriaud
Jacques Lacroix
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-2837-8

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